Patellar tendon thickness, tear thickness may help determine success of surgical repair
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Partial patellar tendon thickness correlates strongly with a partial tendon tear and tracking changes in tendon thickness by MRI may predict the effectiveness of nonoperative treatment in athletes, according to a recently published study.
“On the basis of these results, surgeons should consider operative treatment for patients with patellar tendon thickness [greater than] 11.5 mm or tear thickness [greater than] 50% on axial MRI who have failed nonoperative treatment for 6 months,” the authors wrote.
Of 85 athletes who had patellar tendinopathy (72 male patients, 13 female patients; mean age, 24.9 years), investigators found 65% were confirmed for partial patellar tendon tears. Patients with a partial tear had a mean tendon thickness of 10 mm as compared with axial MRI views of 6.2 mm for those without these tears.
After failing nonoperative care for more than 6 months, 20% of patients with a tear of more than 50% thickness underwent surgical repair. Investigators found a significant correlation between patellar tendon thickness and the percentage of tear thickness, a moderate correlation for width of the tendon and the percentage of tear width, and no significant correlation between the length of tendon and the tear length.
Overall findings in logistic regression revealed tendon thickness of greater than 8.8 mm correlated with the presence of a partial tear. Tendon thickness of greater than 11.45 mm partnered with a tear thickness of greater than 55.7% predicted the need for surgery in patients, according to the study. – by Kate Burba
Perspective
Back to TopMiho J. Tanaka, MD
The authors offer a comprehensive analysis of a large series to describe a new classification system and add imaging characteristics to the current standard of the Blazina score for patellar tendon symptoms. Based on their system, they recommend operative treatment for patients with patellar tendon thickness greater than 11.5 mm or tear thickness of greater than 50% who have failed nonoperative treatment for 6 months.
While the majority of cases did not require surgical treatment, in those who did undergo surgery, only six of 11 patients returned to sport, indicating that surgical solutions may not fully address these more severe cases. Despite this, the authors contribute a new scale to address the location, as well as the severity of patellar tendon partial tears, and offer insight on a condition that can be difficult to treat. Further studies are needed to determine the optimal methods to predict and improve rates of return to sport for those who fail conservative management with this condition.
Massachusetts General Hospital
Harvard Medical School
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